Low back pain is the second most common reason patients visit a doctor, and approximately 80 percent of the U.S. adult population will suffer a serious episode of disabling back pain in their lifetime. In addition, back pain is the most common cause of disability for patients under 45 years of age. However, less than seven percent of the population will develop recurrent or chronic back pain, and fewer than one percent will require back surgery.
How is it diagnosed?
A list of possible diagnoses of low back pain is developed before and especially after all of the symptoms, physical findings, imaging studies and laboratory tests are analyzed. Often, one diagnosis can be firmly established if all of the appropriate examinations and studies are performed.
What are the treatment options?
The vast majority of patients with low back pain recover with or without medical treatment. However, patients who develop acute, sudden back pain may suffer significantly until it resolves, which may take days or even weeks. Chronic spinal conditions may take months or years to settle down on their own. Therefore, most physicians recommend the use of medications to help relieve spinal pain and speed up the recovery process.
Specific oral (taken by mouth) medications listed below generally allow patients with spinal pain to improve, and improve more rapidly, as well as reduce inflammation and the likelihood of a recurrence of symptoms. Medications often prescribed include:
- Anti-inflammatories (NSAIDS)
- Muscle relaxants
Because spinal disorders often generate pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently prescribed pain-relief medications for mechanical neck and back pain worldwide. NSAIDs include ibuprofen and naproxen and are available over-the-counter without a physician prescription. Stronger NSAIDs such as ketorolac or indomethacin are also available by prescription. NSAID medications work by reducing the inflammation and swelling, which typically reduces the pain as well. NSAIDS should not be used by patients with severe kidney disease.
Acetaminophen (Tylenol) is a common, over-the-counter medicine that favorably decreases pain in many patients with spinal pain. Acetaminophen should not be used by patients with severe liver dysfunction.
Muscle relaxants are another category of medicine, which are routinely prescribed for spinal disorders. These medications work by decreasing muscle spasms, which can promote pain and inflammation.
These are controlled, prescription medications that are used specifically for pain. Narcotic medications, such as Tylenol with codeine or Tylenol with oxycodone, are mainstays for the short-term treatment of severe neck or back pain, but should be used sparingly for patients with chronic spinal pain.
Corticosteroids such as methylprednisolone or prednisone are appropriate for patients with significant radicular nerve pain, such as sciatica from a disc herniation. However, patients with diabetes should be carefully followed because steroid medicines can disturb sugar metabolism.
This type of medication, which can stabilize nerve membranes and decrease nerve inflammation, are frequently effective for patients with significant nerve pain unrelieved by other medicines or treatments.
Physical therapy can aid in achieving and maintaining optimal health of a patient’s spine and alleviating pain. Overall, the goal of physical therapy is to identify and teach patients efficient management strategies to improve spine-related problems with an emphasis on decreasing current pain symptoms, improving strength and function and minimizing recurrence of symptoms. Physical therapy, with or without other conservative treatments, can often cure spinal pain, as evidenced by the fact that fewer than one percent of patients with neck or back problems ultimately go on to have a spinal surgery.
The USC physical therapy group provides top-level conservative treatment with a primary focus on spinal stabilization to improve the strength, endurance, balance and control of abdominal, trunk and back muscle groups. Patients are issued a program booklet and personally instructed by the therapist on strengthening exercises. As patients strengthen their core and back muscles and improve their flexibility, more of the joint-loading forces of the spine are stabilized by the muscles. There is less strain on the injured disc and ligaments, which generally leads to less inflammation and pain.